Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3003233 | KY |
NPI | 1992066559 |
---|---|
Provider Name | Devonna Giles Maguet |
First Address | Gray, KY 40734-6529 |
Second Address | Gray, KY 40734-6529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00259 | MEDICARE PTAN ASSOCIATED WITH OFFICE NPI NUMBER 1386781789 (01) | KY |
7100301900 | (05) | KY |
K103140 | MEDICARE (01) | KY |